VISION OF NURSES WORKING. VISION WITH DISABLED CHILDREN ABOUT THEIR PROFE-SSIONAL COMPETENCE

: The nurse’s work with children with disabilities requires narrowly profiled knowledge to ensure adequate medical and health care for children in the process of deinstitutionalization. Purpose: The purpose of the research is to establish the attitudes of nurses regarding the increase of their professional competence for working with children with disabilities in the process of deinstitutionalization. Methods: An anonymous survey was conducted of 109 nurses working in medical and social care homes (HMSCC) in the cities of Burgas and Stara Zagora. For this purpose, a questionnaire consisting of 34 questions of open and closed type was developed. Results: The survey found 68% of respondents believed that a nurse should have a continuous drive to learn new knowledge about caring for children with disabilities. The respondents (75%) indicate that dealing with emergency situations is a mandatory professional competence for those working with children with disabilities, another 55% consider that the ability to emotionally assess the child’s condition is very important when performing their professional activity. The respondents considered that a personal contribution of the nurse (outside of professional duties) is necessary for the improvement of care for children with disabilities [t(107) = 5.814; p-level < 0.001]. Conclusion: The survey found a positive attitude of the respondents to participate in postgraduate studies. The respondents express a desire to become involved as trainers of parents to provide real knowledge and skills in order to deal with and solve the child’s health problems that arise at home.


INTRODUCTION:
In recent years, efforts have been made to improve the quality of health care in order to satisfy the desire of those in need of highly specialized medical care, including health care for children with disabilities.The development of modern technologies is increasingly changing life, which implies the improvement of health and social policies.This allows the training of future medical specialists to be carried out through information and communication technologies or, increasingly, the training process to be implemented in a virtual environment.This, in turn, is a natural step for an ongoing change in the quality of life of children, especially those with disabilities.
Systematic underfunding of the health care system led to an outflow of those wishing to study medical specialities and the migration of young specialists [1].
The change in the vision and implementation of health care for children with disabilities is a complex process, requiring well-grounded policies on the part of the institutions responsible for their implementation in defense of their interests.The clinical skills of nurses are the heart of any health system and are critical to its progress.The specificity of working with disabled children stimulates the nurse to feel needed, worthy, responsible and useful in her work towards them, and this is an incentive to show her professional capabilities.
Professional competence can be defined as the ability to perform a specific task in a way that leads to desired results.This definition implies the ability to apply knowledge and skills to new situations as well as familiar tasks [2].The formation the professional competence of the nurse will allow her to coordinate and achieve the desired results.
Tested and well-verified good practices for motivating people at work, "adequate pay for work", "good organization of work", and "number of days off per year" [3].
In the profession of a medical specialist, moral values are fundamental for the optimal implementation of health care.Children with special needs present a challenge to those who care for them [4,5].Communication skills are extremely important for the nurse's active role in working with patients [6].
Medical professionals who care for children with disabilities need to be trained in modern care to ensure the maintenance of children's lives at home, but their training is limited [7].The need to increase the professional competence of medical specialists will form a vision of care that will guarantee better complexity in the medico-social well-being of children with disabilities.According to studies, the opinion is formed that the nurse is the most qualified specialist in the care of children with disabilities, but additional nursing skills are required from her [7].
Coordination of care for children with disabilities is a complex process that must be monitored during the period of hospitalization and after discharge to the community.Findings from a number of studies may contribute to clarifying the perceptions and experiences of parents of children with special health needs regarding the continuum of care from hospital to community care [5].

MATERIALS AND METHODS:
The survey was conducted in the period 2021-2022.
For this purpose, a questionnaire consisting of 34 questions of open and closed type was developed.The questionnaire is constructed in three modules -demographic indicators, professional competences and personal qualities necessary for the modern vision of the nurse when working with disabled children.The data are processed with Microsoft Office Excel 2016.
Limitations of the study stem from assessments by medical professionals, which are often imprecise and unsystematic.Another limitation is the specificity of the researchers, who do not yet have professional experience in the process of deinstitutionalization and are influenced by subjective evaluations of sources of information regarding the care of children with disabilities as authoritative.

RESULTS
The survey found that 68% of nurses indicated the necessary competencies, such as "continuous learning of new knowledge about caring for children with disabilities", as paramount, and 55% considered the ability to work in a multidisciplinary team to be important in the implementation of medico-social care for children (Fig. 1).The analysis found that 75% of respondents listed emergency coping skills a top, another 68% ranked teamwork skills as a priority.According to 55% of nurses, the ability to assess the child's emotional state is decisive in daily care.A little over half of the respondents, 52%, define strengthening practical skills as necessary when caring for children with disabilities (Fig. 2): Fig. 2. What skills should have a nurse working with disabled children It was found that 57% of the nurses expressed a desire to be included in training modules for parents, thus, specific qualities and competencies will be formed in the respondents, as well as confidence and trust will be built in the parents of children with disabilities (Fig. 3):

Fig. 3. Participation in training for parents
The modern vision of the nurse includes a continuous process of acquiring new knowledge and skills in order to be adequate to the new needs and demands of society.Her professional competence is a complex of knowledge and competencies motives, attitudes and personal contribution.According to the respondents (57%), the personal contribution is essential for the image of the nurse regardless of working conditions (Fig. 4):

DISCUSSION:
The professional competence of nurses caring for children with disabilities requires continuous upgrading training, which will ensure the implementation of modern approaches in health care.
Nursing training should be a continuous process to improve the service delivery model for children with disabilities and their families [8].
Research shows that physical childcare is prioritized as more important than communication and relationships.Nurses and parents state that this has been done, and training for health professionals is needed [9].
Nurses' professional competence in conducting parent education has a positive effect on children's behavior and the psychological state of parents who have children with special needs [10].
Training nurses in telehealth, or the use of telecommunications technology and infrastructure to deliver health care and information to support the needs of children with disabilities, is particularly beneficial Telehealth can also reduce disparities for children and youth with special needs.The inclusion and implementation of telehealth will improve the effectiveness of health care in the process of deinstitutionalization, and optimal results will be achieved in the care of children with disabilities [11,12,13].
Reorganization in the care of children with disabilities is also associated with a change in coordination between teams in the care of children with disabilities in the transition from institutional to deinstitutional care [14,15].
Children with disabilities placed in foster families are at higher risk for their health, and therefore, the role of the nurse and health service providers is leading in planning health interventions for children [16].
Due to the opportunity for continuing education, which proves to be crucial for the quality of health care and patient safety, nurses receive the new knowledge they seek and upgrade their education to be adequate to innovations and competitive in the ever-changing conditions in healthcare and for patients (including children with disabilities) safe and high-quality health care is guaranteed [17].
The significance of continuous professional development and lifelong learning for healthcare professionals ensures that their professional expertise keeps up with the latest advances in medical science and practice, contributes to improved patient outcomes and enhances public confidence in the healthcare professions.
The analyses of the study are indicative of the inclusion of nurses in educational programs that would allow the formation of a high professional level of their knowledge and optimization of health care.

CONCLUSIONS:
The study found nurses' desire to acquire new knowledge which will build a new vision in the care of children with disabilities.Involvement in training projects aimed at parents of children with disabilities will form professional self-confidence in working nurses, which in turn will improve care for children at home.
At the national level, a plan has been drawn up for a Vision for the deinstitutionalization of children in the Republic of Bulgaria, which, however, does not include increasing the professional competence of specialists caring for children with disabilities.This necessitates an urgent increase in the professional competence of nurses.

Fig. 1 .
Fig. 1.Necessary competencies in the care of children with disabilities